Wound treatment

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 18.12.2020

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Synonym(s)

Wound therapy

Definition
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Preliminary or final treatment of a tissue defect with secondary healing. Classification according to the depth of the tissue defect (see below wound, chronic):
  • Erosion: Superficial intraepidermal tissue defect
  • Excoriation: tissue defect with injury to the papillary body
  • Ulcer: Deep tissue defect with extension at least into the corium.

General definition
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Wound: Separation of the tissue connection on external or internal body surfaces with or without tissue loss. A chronic wound is considered to be a wound that has existed for more than 2-3 weeks.

Infected chronic wounds: signs of infection such as redness, swelling, fever, pain, increased secretion, foetal odour are signs of wound infection. But: Every chronic wound is bacterially contaminated! An infection should always be treated with systemic antibiotics. The sensitivity of the germs can be determined by an antibiogram. Antiseptics should only be used in heavily bacterially contaminated wounds and in clinically manifest wound infections for no longer than 2-6 days. Prolonged use inhibits wound healing (cytotoxicity, granulation inhibition). In the long term, physiological saline solution is recommended for cleaning or other treatment of the wound (e.g. to remove dressing residues).

Notice! Local applications of antibiotics to chronic wounds are obsolete!

Local application of antibiotics may lead to the development of polyvalent contact allergies, the development of resistance and thus a decisive disturbance of wound healing. Furthermore, the assessment of the healing process is made more difficult by increasing secretion of the "sensitised wound". Nor are dyes and organic mercury compounds indicated for wound treatment today.

Notice! Dyes are locally incompatible and insufficiently effective. Mercury compounds lead to sensitisation and have systemic side effects! Hydrogen peroxide is considered dispensable, as it has a cyotoxic effect, inhibits fibroblasts and can lead to necrosis.

Antiseptics are recommended:

Polihexanide (Lavasept): due to its good tissue compatibility, the product of choice for chronic or sensitive wounds, onset of action after 5 to 20 minutes.

Octenidine dihydrochloride (Octenisept): starts working after 30 seconds to >5 minutes, also shows good tissue tolerance.

Polyvidone iodine (Betaisodona, Braunovidon): rapid onset of action within 30 seconds, lasting as long as the presence of iodine is indicated by brown coloration. For chronic wounds, the manufacturer recommends a dilution of 1:2 to 1:20 with Ringer's solution or physiological saline solution.

Debridement: removal of non-vital tissue from a wound. It should be the first step in the phase-oriented treatment of chronic wounds see below. wound debridement).

Wound dressings:

  • Polyacrylates (see below gels, hydrophilic): They belong to the group of synthetic wound dressings. It is a cushion-shaped wound dressing containing a so-called superabsorbent polyacrylate. The superabsorbent is activated with Ringer's solution, which is continuously released into the wound and simultaneously absorbs secretions. This results in a suction-rinsing effect with very good cleansing properties. Examples include TenderWet 24, TenderWet Duo.
  • Hydrogels: Hydrogels consist of carboxymethyl cellulose, pectin, propylene glycol and, depending on the product, have a water content of up to 60% and can be combined with calcium alginate. Due to the high water content they are well suited for dissolving fibrinous, necrotic, dry coatings and for rehydration of wounds. The absorption of secretions is therefore limited.

    Note!

    Hydrogels carry the risk of wound edge maceration. Examples include NU hydrogel with alginate, Varihesive hydrogel, Suprasorb G Amorphous Gel Intrasite Gel Comfeel Gel.
  • Alginates: Alginates are mainly used in the cleansing phase and for moderate to severe wound secretion. They are available as compresses and tamponades. Alginates consist of salts of alginic acid, which are extracted from brown algae. Due to their swelling properties they are suitable for wound cleansing. On contact with the wound secretion, insoluble calcium alginate is converted into soluble sodium alginate by exchanging the calcium ions for the sodium ions present in the blood and wound secretion. This causes swelling and produces a gel which fills the wound and ensures a moist wound environment. This ion exchange also has a hemostyptic effect. Alginates can bind up to 20 times their own weight to secretion. Examples: Kaltostat, Sorbsan calcium alginate, Sorbalgon, Algosteril, Suprasorb A.
  • Hydrofibre dressings: These can be used up to the epithelialisation phase, are made of sodium carboxymethylcellulose and are available as compresses and tamponades. They offer high absorbency (30 g secretion/g hydrofibre), wound secretion is only absorbed vertically and not horizontally. When applied overlapping the wound edges, they are therefore very well suited as wound edge protection in macerated and eczematised wound environments. They can be ideally applied in cases of polyvalent contact allergy. In dry wounds, additional moistening with physiological saline solution or Ringer's solution is recommended. Examples include Aquacel, Aquacel Ag, Textus multi.
  • Silver-containing wound dressings: Ionic silver has recently regained importance in wound treatment due to its broad antimicrobial spectrum of activity. It acts mainly by disrupting DNA synthesis and binding to structural and functional proteins of the bacterial cell. In contrast to other antiseptic substances, silver has a very low toxicity. Various material combinations with silver ions or nanocrystalline silver are available. The use of wound dressings containing silver is indicated for infected and highly bacterially contaminated wounds (Actisorb silver contains activated carbon fibres impregnated with silver; activated carbon absorbs bacteria, secretion, detritus and odour; silver has a bactericidal effect; Acticoat contains nanocrystalline silver which remains active for 3 days. It must be moistened with sterile distilled water to be activated. When using saline solution, AgCl is formed and the silver ions are inactivated. If the dressing is too dry, silver deposits will form on the wound. The blue side of the pad must be placed on the wound. Acticoat can be left on the wound for up to 3 days, a secondary dressing is necessary.
  • Foam and hydropolymer dressings: These can be used until the epithelialisation phase. They consist of a polyurethane foam as a reservoir and a semi-permeable polyurethane surface with or without an adhesive edge. They are structurally stable, non-dissolving bandages which swell on contact with secretions. The dressing is also changed here depending on the secretion behaviour of the wound. In addition to the absorption of exudate and cellular detritus, a pressure and suction effect is exerted on the wound bed, which promotes granulation. Products without an adhesive edge are suitable for tamponade of wound cavities, in the case of unstable wound surroundings or for the passant covering of defects in surgical wounds. Examples include Tielle (sacrum, plus, borderless, lite), Allevyn (non-adhesive, adhesive with adhesive edge, heel heel dressing, sacrum, cavity), PermaFoam, Contreet foam Ag (adhesive, non-adhesive), Suprasorb P, Mepilex (border).
  • Hydrocolloids: They can be used until the epithelialization phase. They are semi occlusive wound dressings based on pectins, gelatine and cellulose derivatives. Hydrophilic colloidal particles are inserted into a hydrophobic polymer framework, above which there is a semi-permeable (impermeable to liquids and germs, permeable to gases) polyurethane surface. On contact with secretions, the hydrophilic particles swell to form a gel, causing a loss of adhesion to the wound surface. Clinically, this can be seen as blistering. In this moist wound environment, fibroblasts and macrophages are activated and growth factors are expressed, thereby promoting angiogenesis and keratinocyte proliferation. Where there is no contact with wound secretion, the dressing adheres to the skin. The wound environment should therefore be stable and free from irritation and eczema. For special localisations such as the heel or sacral area there is an additional fixation margin for better adhesion. Hydrocolloids may remain on the wound for several days to a maximum of one week depending on wound secretion; they should not be applied to infected wounds. A gel forms under the hydrocolloid dressing which must be removed with Ringer's solution or physiological saline solution when the dressing is changed. Possible maceration of the wound margin by the gel can be minimised by combination with a hydrofibre dressing. Examples include Suprasorb H (standard, thin, border, sacrum), Varihesive E (border,extra thin), Hydrocoll (concave, sacral, thin). Combination products include Contreet H (hydrocolloid dressing with silver ions which are released during the swelling process); CombiDerm (hydrocolloid with superabsorbent wound pad); Comfeel plus (hydrocolloid dressing with calcium alginate).
  • Proteaseregulating wound dressings: These consist of a freeze-dried matrix of bovine collagen and oxidised, regenerated cellulose. It is used in stagnant wounds in the granulation phase without fibrin coating until the epithelialisation phase. Proteases (matrix metalloproteinases, elastases, plasmin) are present in excess in chronic wounds and inhibit or inactivate growth factors. Due to the large surface area of this matrix, proteases are bound and inactivated, endogenous growth factors are bound and thus protected. These growth factors are released again in their active form upon resorption of the matrix. Free radicals are bound and cell proliferation is promoted. The matrix also has a haemostatic effect and ensures a moist wound environment. It can be used in combination with hydrocolloids and foils. Example: Promogran.
  • Biodegradable calf collagen: This is commercially available as a sponge structure and can be used for stagnant wounds in the granulation phase. Exudate, detritus and proteases are bound, thus promoting the migration and proliferation of fibroblasts and thus collagen synthesis and subsequently re-epithelialisation. The sponge structure ensures a moist wound environment, combination with hydrocolloids is possible. Examples include Suprasorb C.
  • Vacuum Assisted Closure System (VAC): The VAC therapy unit is used to continue effective wound cleansing after sufficient surgical debridement and especially in the granulation phase. By applying a continuous or intermittent negative pressure with the aid of a sponge, the wound surface is reduced by wound retraction, the formation of new granulation tissue and the blood flow to the wound bed is promoted, wound exudate is removed and the bacterial count is reduced. The black polyurethane sponge is coarse-pored and dry and is used for heavily exuding and infectious wounds. The white polyvinyl alcohol sponge has fine pores and is hydrated, prevents tissue ingrowth and is particularly suitable for protecting tendons, nerves and vessels. The Minivac system is also suitable for outpatient use. It is used for 1-4 weeks; for the epithelialization phase a different dressing system must be used or surgical coverage can be considered.
  • Tissue engineering products (currently still experimental approaches): These actively intervene in wound healing and are made from autologous, allogeneic or xenogeneic cells. The prerequisite for application is a cleansed, infection-free wound. They are reserved for special indications only, as they are currently still very expensive. Examples of tissue engineering products currently available in Europe with approval Ulcus cruris venosum are Epicel (keratinocyte autograft), Epidex (autologous keratinocytes from hair root cells), Laserskin Autograft (hyaluronic acid sheets seeded with autologous keratinocytes) and Bioseed-S (autologous keratinocytes suspended in fibrin glue).
  • Growth factors: The clinical results from available clinical studies are not yet satisfactory. Their clinical use of growth factors is therefore reserved for specific indications. A cleansed and infection-free wound is a prerequisite for use. The only preparation currently approved is Regranex-0.01% gel containing becaplermine, a recombinant human platelet growth factor. It is approved for neuropathic and diabetic ulcers up to a maximum of 5 cm2. Example: Regranex-0.01% gel.

Implementation
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Guidelines for wound treatment see Table 1, promotion of wound healing see Table 2; see also Decubitus.

I. Erosion: One-time disinfecting solution such as Polyvidon iodine solution(e.g. Betaisodona solution).

II. excoriation: Like erosion, cleaning and sterile covering if necessary. In case of signs of inflammation, especially with continued signs of inflammation, smear and antibiosis after antibiogram.

III. ulcer: In chronic wounds, wound cleansing, debridement and exudation control are the three critical factors. The older concept of phase- or stage-specific therapy is increasingly being abandoned today, as the cleansing phase, granulation phase and epithelisation often occur in parallel in the different wound areas.

  1. Wound cleaning: Cleaning of dirty, infected, necrotic and also pre-treated wounds:
    • Superficial coatings can be dissolved by baths with the addition of quinolinol (e.g. quinosol, R042 ), chamomile, potassium permanganate or also with Ringer's solution. Disinfectants with good effectiveness and lower tissue toxicity are polihexanide (Serasept, Prontoderm, Prontosan) and octenidine (e.g. Octenisept). Many older wound disinfectants, particularly dyes such as gentian violet solution but also hydrogen peroxide, impair wound healing with only a low disinfectant effect. Therefore do not use for wound treatment!

    • Periulcerous environment: Ointment residues in the ulcerous environment are removed with vegetable oils, e.g. olive oil (Oleum olivarum). Firmly adhering necroses can usually only be removed mechanically with a ring curette, a sharp spoon or with tweezers and scissors or scalpel. For very pain-sensitive patients, local or surface anaesthesia, e.g. with EMLA cream, may be necessary. If necessary, enzymatic wound cleansing e.g. with clostridiopeptidase (e.g. Iruxol N ointment) may be considered. Hydrogels have also proved to be effective which, in addition to softening plaque and necroses in the granulation phase, can be used to promote healing, e.g. NuGel. In case of accompanying eczema reactions (e.g. contact allergic etiology) initial therapy with topical glucocorticoids in vaseline bases, e.g. 0.25% prednicarbate (e.g. Dermatop fatty ointment), later bland care with largely indifferent bases (e.g. Vaselinum album) or previously epicutaneously tested preparations. In addition, also existing, e.g. iatrogenically caused dehydration eczema after intensive moisturizing treatment should be treated with indifferent fatty ointments. In the case of heavily exuding wounds, it is advisable to cover the wound area to protect it from irritation with e.g. zinc paste (Pasta zinci DAB) or pure vaselinum, and special wound dressings, e.g. calcium alginates, are also used.

  2. Exudate control: A variety of preparations are available (see Table 3).
    • Superficial ulcers: Hydrocolloid foils (e.g. NuDerm) have proven to be effective for clean, non-secreting and superinfected ulcers. For less secreting ulcers, wound dressings with a limited fluid absorption capacity, such as hydrogels or foils (e.g. Bioclusive, Cutifilm plus, Tegaderm) are also suitable. Synthetic wound dressings are an effective microbial barrier and offer good mechanical and thermal protection. Dressing changes are generally painless and without trauma, so that they are well tolerated by patients (see also Table 4).

    • Deep ulcers: Gels (e.g. Intrasite Gel, Varihesive Hydrogel) or alginates (e.g. Trionic) are well suited for filling deep wounds and niches, as they unfold with the secreted fluid of the wound and create a moist wound environment there.

    • Secreting ulcers: Wound dressings with high absorption capacity such as foam dressings (Allevyn, Cutinova Foam) or alginates. A good alternative is VAC (vacuum) therapy, a moist wound treatment under continuous vacuum. The available study results do not yet permit a final overall assessment of the procedure (see VAC below).

    • Germ reduction: Wound dressings with elemental silver (e.g. Actisorb, Acticoat, Aquacel Ag) have a good antiseptic effect. Activated carbon also serves to reduce odour in heavily exuding wounds. Alternatively, cadexomer iodine, polyvidon iodine, octenidine or polihexanide can be used.

  3. Epithelialisation:
    • Conservative: In most cases, the preparations not only promote granulation but also epithelialisation. Hydrocolloid film bandages, hyaluronic acid compresses (Hyalofill F), plastic pads/foam compresses such as (e.g. Mepilex, Cutinova) and fatty gauze (e.g. Oleo-Tuell or Jelonet) are used.

      • Zinc: The control of the zinc level is recommended for long lasting healing processes. If necessary, zinc substitution with zinc sulphate (e.g. Zinkit 20) once a day p.o. with weekly control of the serum zinc level (normal 80-120 μg/dl) and zinc excretion in 24-hour urine (normal 200-500 μg/24 hours).

      • Growth factors: The local application of various growth factors has so far been the subject of experimental studies, but has been shown to have healing effects.

      • Antibiosis: In clinical signs of inflammation (reddening, overheating, swelling of the wound bed, increased exudation, pain), especially with progressive signs of inflammation, smear and antibiotic treatment after antibiogram.

    • Surgical: In the absence of epithelization, a split skin transplant or mesh graft may be considered as an alternative. Prerequisites are a clean wound bed, removal of a venous stasis in venous ulcer, possibly shave excision of the sclerotic ulcer bed. Furthermore, the transplantation of autologous and/or heterologous keratinocytes is possible. In the case of large and/or deep wound defects or excessively long wound healing, primary surgical wound care with necrectomy, incision and subsequent plastic defect coverage may be necessary (full-thickness flap plasty/Reverdin plasty, musculocutaneous flap plasty, etc.)

Undesirable effects
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Patients with chronic wounds often also acquire clinically relevant contact sensitisation. The most common contact allergens are Peru balsam, Amerchol L-101, fragrance mix, wool wax alcohols and colophony.

Note(s)
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phytotherapy:

The phytotherapeutic indication can be used as monotherapy for minor wound problems. The following phytotherapeutic agents are suitable for this purpose:

Camomile extracts (Matricaria recutita)

Marigold extracts (Calendula officinalis)

St. John's wort extracts (Hypericum perforatum)

Hamamelis extracts (Hamamelis virginiana)

Accounting notes:

Digit 5 GOÄ: This digit is in the singular and can only be charged once per session. If several examinations are performed in one session (e.g. in the case of multiple chronic wounds on both legs), an increase in the factor may be justified.

Figure 2006 GOÄ: This figure can be charged per wound. An increase in the factor may be justified in the case of "oversized expansion, very deep wounds or superinfected wounds. An increase in the factor could also be justified by the application or changing of a wound tampon.

Digit 204 GOÄ: This digit can only be calculated once per leg. In the case of an extended compression bandage, this figure can be increased (Reason: very complex compression bandage)

Digit 200 GOÄ: These digits can be billed together with the digit GOÄ 204 (also multiple).

Paragraph 34 GOÄ: In the case of an "initial consultation involving extensive and comprehensive preliminary findings", or in the case of "extensive consultation to optimise therapy" or consultation in the case of "problems with changing medication", this paragraph can be applied.

Literature
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  1. Eisenbud D et al (2003) Hydrogel wound dressings: where do we stand in 2003? Ostomy Wound Manage 49: 52-57
  2. GOÄ-Tipp (2015) Billing with higher factors in wound care. Vasomed 27: 204
  3. Grotewohl JH (1993) Phase-adapted therapy of the leg ulcer using a hydrogel wound dressing. 7: 3-10
  4. Hagedorn M et al (1995) In vitro and in vivo studies on local disinfection and wound healing Dermatologist 46: 319-324
  5. Karlsmark T et al (2003) Clinical performance of a new silver dressing, Contreet Foam, for chronic exuding venous leg ulcers. J Wound Care 12: 351-354
  6. Kraft E (2015) Phytotherapy in wound healing. Vasomed 27: 177-178
  7. Lehnen M et al (2006) Contact sensitisation of patients with chronic wounds. Dermatologist 57: 303-308
  8. Moll I et al (1995) Application of keratinocytes in the therapy of leg ulcers. dermatologist 46: 548-552
  9. Peinemann F et al (2011) Vacuum therapy of wounds. Dtsch Ärztebl 108:381-389
  10. Phillips TJ et al (1991) Leg ulcers. J Am Acad Dermatol 25: 965-987
  11. Schmidt K et al (1996) Therapy of the leg ulcer with synthetic wound dressings Z Hautkr 71: 254-259
  12. Vranckx JJ et al (2002) Wet wound healing. Plast Reconstr Surgery 110: 1680-1687
  13. Weinberg JM et al (2003) Cutaneous infections in the elderly: diagnosis and management. Dermatol Ther 16: 195-205

Tables
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Clinic and therapy of wounds

Incision wound

Smooth wound edges (special form of surgical wounds)

Primary surgical wound care

Laceration wound

Lacerated crush wound mostly over bone with tissue bridges

Disinfection, wound edge excision, attempt at wound edge adaptation

Laceration wound

Torn wound edges, risk of infection

Disinfection, excision of wound edges, drainage, primary wound suture, antibiosis

Decollement

Layer-by-layer detachment of the skin

Attempt of replantation, otherwise plastic-surgical covering

Bite wound

Stab/crush wound

In principle, no primary suturing (exception: child's face), risk of infection, debridement, open antiseptic wound treatment, immobilisation, clarify risk of rabies, tetanus vaccination, antibiotic treatment (e.g. tetracycline) if necessary.

Scratch wound/abrasion wound

Superficial epidermal defect

Disinfectant measures (polyvidone-iodine ointment dressing)

Puncture wound

Check injury to deeper structures, X-ray, foreign body?, risk of infection

No suture, disinfectant measures, open wound treatment (Polyvidon-iodine)

Gunshot wound

Bullet through/stuck-in wound, X-ray check with surrounding soft tissue

Cleaning, disinfection, open disinfecting wound treatment

Burn wounds

see below Burns

Chemical wounds

see below Chemical burns (coagulation necrosis and alkali colliquation necrosis)

Thermal wounds

After exposure to heat

see below Burns or after exposure to cold see below Frostbite

Radioactive wounds

X-ray fibrosis, X-ray keratosis, X-ray ulcer, X-ray carcinoma

Promotion of wound healing

General

Local

Treatment of metabolic disorders

Mechanical wound cleansing (debridement, wound irrigation etc.)

Treatment of cardiovascular diseases

Possibly enzymatic wound cleansing (e.g. Iruxol N ointment)

Compensation of deficiencies

Application of wound healing factors (TGF)

Discontinuation/dosage reduction of medications that interfere with wound healing

Germ reduction

Prevention of general infections

Measures to promote wound healing (dressings, compression, ointments, gels, wound cleansing and wound care)

Treatment of arterial and/or venous vascular diseases

Infection prophylaxis and control (germ reduction)

Treatment of stasis oedema

In the case of venous stasis: compression stockings, permanent bandages (e.g. four-layer bandages). Only temporary compression bandages with short-stretch bandages (e.g. Pütter bandage).

Wound treatment options with interactive/bioactive wound dressings

Materials

Contents

Examples

Remarks

Biological skin substitutes

Homologous, heterologous

keratinocyte transplants, split skin, full thickness skin

Promotion of epithelialization

Temporary skin substitutes

Foams

Epigard, Vacuseal, Syspurderm

Promotion of epithelialization

Organic materials

Collagen

Suprasorb C collagen wound dressing

Promotes wound healing in all phases

Fleece Fabric

Cellulose

Vliwazell

Absorbent and wound cleansing

Foams, hydropolymers

Polyurethanes, Silicones

Epigard, Cutinova plus, Tielle, Allevyn, Mepilex, Mepilex Ag

Promotes granulation and epithelisation, absorption of exudate, detritus and bacteria. Secretion absorption occurs by capillary action. Promotion of granulation by mechanical stimulation. Large-pored foams are used for wound cleansing. Small-pored foams have low adhesion and are easy to change. Polyurethanes are often combined with silicone, contain activated charcoal and carry silver-containing additives. Some products also contain nonwoven and/or cellulose. Relatively cost-intensive therapy method.

Plastics/Films

Polyurethane, polyethylene, polyacrylate, polyamide

Self-adhesive films, e.g. Tegaderm, Bioclusive Select, Opsite Flexigrid, Opraflex,

Mepore

Covering material for non-infected epithelial defects.

Plastics with elemental silver (e.g. nanocrystalline silver)

sandwich-like structure of outer, silver-coated and non-adhesive nets made of polyethylene as well as moisture-retaining core plastics

Acticoat 7

Effective dressing principle due to the exceptional effective structure of nanocrystalline silver and moisture cores. Use on superinfected wounds or wounds at risk of infection. Change of dressing 1-2 times/week.

Hydrocolloids, hydrogels

Elastomer + swellable hydrocolloid

Varihesive hydrogel, Comfeel, Geliperm, Nu-Gel, Cellosorb adhesive, Cellosorb non adhesive

Hydrocolloids: Can be used in all phases of wound healing in non-infected wounds. Creation of a moist wound environment through semi-permeable closure. Advantage: the dressing material is moist itself. Absorbency is limited due to swelling agents (gelatine, cellulose, superabsorbents, etc.). Therefore, frequent changes may be necessary in the case of highly exuding wounds. More cost-intensive procedure than e.g. alginates. The indication is particularly in wounds with moderate fluid secretion, most likely in the proliferation or granulation phase.

Hydrogels: good absorbency; absorption of wound secretion; already moist as compress (initial supply of moisture to the wound); also for detaching initially dry necroses (due to moistening effect of the gel). Comparable in price to hydrocolloids.

Films: primarily suitable for creating an occlusive environment. Alginates, polyurethane foams, ointments, compresses or ointment dressings can be used under foils. Films are not absorbent, but because of their transparent surface they can be easily inspected without changing the dressing. The indication area in wound healing is particularly in the epithelialisation phase or as an adjuvant in the use of alginates, hydrocolloids or polyurethane foams. Low therapy costs.

Alginates

Alginic acid (brown alga)

Algosteril, Trionic, Comfeel Alginate

Good absorbency, absorption of exudate, detritus and bacteria; used for highly exuding and deep wounds (good tamponability). Alginates can be left in place as long as the fibrous structure is visible (usually 3-5 days), therefore they are a therapeutic method with a relatively favourable price-performance ratio. Alginates can also be covered with foils.

Activated carbon

Activated carbon

Vliwaktiv activated charcoal wound dressing

For exudative/contaminated/infected wounds or wounds at risk of infection for physical wound cleansing as well as odour neutralisation. Secondary dressing may be necessary to absorb wound secretions (e.g. hydrocolloid, foam, compress and gauze bandage). Principle of action: even with a high bacterial load, bacteria are reliably bound by the activated charcoal content on the surface of the dressing. However, there is no bactericidal effect.

Activated charcoal with elemental silver

Activated carbon/elemental silver

Actisorb silver 220

For exudative/contaminated/infected wounds or wounds at risk of infection for physical wound cleansing as well as odour neutralisation. A broad bactericidal effect is achieved through the application of elemental silver. Secondary dressing may be necessary to absorb the wound secretion (e.g. hydrocolloid, foam, compress and gauze bandage). Principle of action: even with a high bacterial load, bacteria are reliably bound by the activated charcoal content on the dressing surface and killed in or on the wound dressing by the silver content.

Grease gauze

Paraffin or Vaseline gauze

Oleo-Tuell, Jelonet

For dry and slightly moist wounds, promotes epithelialisation, prevents sticking of the dressing.

Gauze grid with antiseptics or antibiotics

e.g. polyvidone iodine, fusidic acid, chlorhexidine

Betaisodona gauze, Inadine, Fucidine gauze, Bactigras

For dry and slightly moist wounds with v.a. microbial colonisation; promotes epithelialisation, prevents sticking of the dressing.

Function of various wound dressings

Wound

Function

Wound dressing/treatment

Black, dry necrosis

Debridement

Curettage, ablation with scalpel and scissors

Moist necrosis (covered wounds)

Debridement

Surgical debridement

Foam wound dressings

Alginates

Activated charcoal

Granulating wound with light to moderate secretion

Secretion absorption, thermal insulation, antimicrobial barrier

Nonwoven fabrics

Hydrocolloids, hydrogels

Alginates

Activated charcoal

Collagen

Foam

Granulating wound with strong secretion

Secretion absorption, temperature isolation, antimicrobial barrier, odour absorbing

Nonwoven fabrics

Alginates

Activated carbon

Modified starch

Foam

Epithelializing wound

Moisture retention, no adhesion, temperature isolation

Grease Gauze

Hydrogels

Film dressings

Hydrocolloid films thin

Pathogen

Antibiotics of choice

Antibiotics of reserve

Staphylococcus

Penicillinase-resistant penicillin, cefazolin

Clindamycin, fusidic acid, vancomycin, teicoplanin, linezolid

Streptococcus

penicillin G, penicillin V

cephalosporins, erythromycin, teicoplanin

Enterococci

Ampicillins

Erythromycin, tetracyclines, mezlocillin, gyrase inhibitors, linezolid

Pseudomonas aeruginosa

Ceftazidime + tobramycin, ciprofloxacin

gentamicin, amikacin, piperacillin, imipenem

Proteus vulgaris

cefoxitin, gentamicin, cefotaxime, ceftazidime

mezlocillin, gyrase inhibitor, piperacillin, imipenem

Klebsiella

Cefoxitin, Gentamicin, Cefotaxime

Gyrase inhibitor, mezlocillin, piperacillin, imipenem

E. coli

Ampicillins, Cephalosporins

Gentamicin, Cotrimoxazole, Mexlocillin

Pasteurella multocida

Penicillin G

Tetracyclines

Bacteroides fragilis

Clindamycin, Metronidazole

Cefoxitin, Imipenem

Clostridium perfringens

penicillin G

Tetracyclines, Cephalosporins, Metronidazole

Authors

Last updated on: 18.12.2020